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Widgren Y, Silén M, Wåhlin I, Lindberg M, Fransson P, Efverman A. Chemotherapy-induced Emesis: Experienced Burden in Life, and Significance of Treatment Expectations and Communication in Chemotherapy Care. Integr Cancer Ther 2023; 22:15347354231217296. [PMID: 38098295 PMCID: PMC10725131 DOI: 10.1177/15347354231217296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/10/2023] [Accepted: 11/13/2020] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE Because antiemetics have become more effective and integrative therapies such as acupuncture are used in combination with antiemetics, people receiving chemotherapy for cancer today might expect less emesis than in the past. It is not previously described if and how people receiving modern antiemetics during chemotherapy experience emesis. The objective of this study was to describe experiences regarding emesis among persons undergoing emetogenic chemotherapy, and how it affects their quality of life, daily life and work. A further aim was to describe views on the significance of treatment expectations and communication with healthcare personnel while undergoing chemotherapy for cancer. METHOD Fifteen participants (median age 62 years, n = 1 man and n = 14 women, with breast (n = 13) or colorectal (n = 2) cancer) undergoing adjuvant or neo-adjuvant highly or moderately emetogenic chemotherapy were interviewed individually. The data were then analyzed using inductive thematic analysis. RESULTS Three themes described the participants' experiences: "Your whole life is affected, or continues as usual," covering descriptions of emesis limiting some participants' everyday lives, while others experienced no emesis at all or had found ways to manage it. Overall, participants described satisfaction with their antiemetic treatment. "Experiences and expectations more important than information", that is, the participants reported wanting all the information they could get about possible adverse effects of treatment, although they believed previous experiences were more important than information in creating expectations about treatment outcomes. The participants reported that being seen as a unique person was of utmost importance: "Meet me as I am." This creates trust in healthcare personnel and a feeling of safety and security in the situation. CONCLUSIONS These findings underline the importance of person-centered care and support in creating positive treatment expectations. Future research is called for regarding the potential antiemetic effects of positive communication regarding strengthening positive treatment expectations during emetogenic chemotherapy.
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Affiliation(s)
- Ylva Widgren
- University of Gävle, Gävle, Sweden
- Region Hospital of Sundsvall-Härnösand, County Council of Västernorrland, Sundsvall, Sweden
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Development of a Quality Assessment Tool for Outpatient Infusion Clinics: A Literature Review and Pilot Survey. JOURNAL OF INFUSION NURSING 2022; 45:165-175. [PMID: 35537004 DOI: 10.1097/nan.0000000000000466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to develop a quality assessment tool for outpatient infusion clinics, as a lack of literature exists on the subject. The authors conducted a literature review targeting studies since 2016 to identify variables that affect patient satisfaction in outpatient infusion clinics. Due to the limited number of relevant studies found, the authors shadowed 2 infusion clinic nurses to capture additional determinants of outpatient infusion clinic quality. A total of 72 variables relevant to an outpatient infusion quality assessment tool were listed. From this list of variables, a pilot survey was conducted at an outpatient rheumatology infusion clinic to assess patient satisfaction with 16 variables of interest. The pilot survey (N = 43) revealed that patients were relatively dissatisfied with walking to clinics, lack of access to public transit, lack of parking and/or free parking, lack of privacy, and flexible scheduling and/or cancellation policies. These findings demonstrate how the assessment tool may highlight specific areas of concern at an infusion clinic to identify targets for future quality improvement initiatives. Therefore, the tool presented has the potential to improve the quality of care provided to patients attending infusion facilities.
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Björnsdóttir EB, Hjörleifsdóttir E, Sigurðardóttir Þ, Baruchello G, Þormóðsson FR. Experiences of cancer rehabilitation among patients in rural areas in northern Iceland: physical and psychosocial well-being, coping, quality of life, and satisfaction with care. A qualitative study. Int J Circumpolar Health 2021; 80:1936974. [PMID: 34114531 PMCID: PMC8204953 DOI: 10.1080/22423982.2021.1936974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 10/31/2022] Open
Abstract
Physical rehabilitation and psychosocial support are a part of cancer patients well-being and their ability to cope. Physical geography and healthcare provider barriers may have negative influences on patients' health outcomes. To explore the perceptions and experiences of cancer rehabilitation in a rural area in northern Iceland. A further aim was to explore patients' physical and psychosocial well-being, coping and satisfaction with care. A qualitative study using semi-structured interviews and thematic analysis was completed with a purposive sample of 21 patients at a tertiary hospital in northern Iceland. Three main themes emerged: 1) Rehabilitation - the need for improved access support and continuity; 2) Coping and quality of life - balancing life as it was before cancer against the present situation in order to achieve normality; 3) Satisfaction - encountering caring behaviours enhances satisfaction and well-being. Specifically targeted rehabilitation programmes need to be included in the treatment options for cancer patients. Survival instinct, coping mechanisms and a strong urge to maintain general functionality are of paramount importance intertwined with patients' ability to cope with the disease and treatment, and their satisfaction with care.
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Affiliation(s)
| | | | | | - Giorgio Baruchello
- Department of Social Sciences, University of Akureyri, Akureyri, Iceland
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Valenta S, Miaskowski C, Spirig R, Zaugg K, Rettke H, Spichiger E. Exploring learning processes associated with a cancer pain self-management intervention in patients and family caregivers: A mixed methods study. Appl Nurs Res 2021; 62:151480. [PMID: 34815011 DOI: 10.1016/j.apnr.2021.151480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/15/2021] [Accepted: 08/03/2021] [Indexed: 11/28/2022]
Abstract
AIM Explore learning processes associated with a psychoeducational pain selfmanagement intervention. BACKGROUND Self-management of cancer pain is challenging for patients and their family caregivers (FCs). While psychoeducational interventions can support them to handle these tasks, it remains unclear how learning processes are hampered or facilitated. METHODS A convergent parallel mixed methods design with qualitative data collection embedded in a randomized controlled trial (RCT) was used. Outpatients with cancer and FCs were recruited from three Swiss university hospitals. The six-week intervention consisted of education, skills building, and nurse coaching. Quantitative data on pain management knowledge and self-efficacy were analyzed using multilevel models. Patients and FCs were interviewed post-RCT regarding their learning experiences. Qualitative data analysis was guided by interpretive description. Finally, quantitative and qualitative data were integrated using case level comparisons and a meta-matrix. RESULTS Twenty-one patients and seven FCs completed this study. The group-by-time effect showed increases in knowledge (p = 0.035) and self-efficacy (p = 0.007). Patients' and FCs' learning through experience was supported by an intervention nurse, who was perceived as competent and trustworthy. After the study, most intervention group participants felt more confident to implement pain self-management. Finally, data integration showed that declining health hampered some patients' pain self-management. CONCLUSIONS Competent and trustworthy nurses can support patients' and FCs' pain self-management by providing individualized interventions. Using a diary, jointly reflecting on the documented experiences, and addressing knowledge deficits and misconceptions through the use of academic detailing can facilitate patients' and FCs' learning of critical skills.
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Affiliation(s)
- Sabine Valenta
- Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Department of Hematology, University Hospital Basel, Petersgraben 4, 4056 Basel, Switzerland
| | - Christine Miaskowski
- School of Nursing, University of California San Francisco, 2 Koret Way - N631Y, San Francisco, CA 94143-0610, United States
| | - Rebecca Spirig
- Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Department of Nursing Science, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
| | - Kathrin Zaugg
- Department of Radiation Oncology, Stadtspital Triemli, Birmensdorferstrasse 497, 8063 Zurich, Switzerland; Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Freiburgstrasse 15, 3010, Bern, Switzerland
| | - Horst Rettke
- Department of Clinical Nursing Science, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Elisabeth Spichiger
- Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland; Department of Nursing, Inselspital, Bern University Hospital, Freiburgstrasse 15, Bern, Switzerland.
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Stover AM, Kurtzman R, Walker Bissram J, Jansen J, Carr P, Atkinson T, Ellis CT, Freeman AT, Turner K, Basch EM. Stakeholder Perceptions of Key Aspects of High-Quality Cancer Care to Assess with Patient Reported Outcome Measures: A Systematic Review. Cancers (Basel) 2021; 13:cancers13143628. [PMID: 34298841 PMCID: PMC8306432 DOI: 10.3390/cancers13143628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/02/2021] [Accepted: 07/14/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary We conducted a review to identify important symptoms reported by patients on questionnaires (e.g., pain) that can be used to compare cancer centers on how well they provide care. For example, cancer centers could be compared on the percentage of patients with controlled pain after adjusting for demographic and clinical characteristics. Standard review methods were used to identify studies through August 2020. Searches generated 1813 articles and 1779 were coded as not relevant. The remaining 34 studies showed that patients, caregivers, clinicians, and healthcare administrators identify psychosocial care (e.g., distress) and symptom management as critical parts of high-quality care. Patients and caregivers also perceive that maintaining physical function and daily activities are important. Clinicians and healthcare administrators perceive control of specific symptoms to be important (e.g., pain, poor sleep, diarrhea). Results were used to inform testing of symptom questionnaires to compare the quality of care provided by six cancer centers. Abstract Performance measurement is the process of collecting, analyzing, and reporting standardized measures of clinical performance that can be compared across practices to evaluate how well care was provided. We conducted a systematic review to identify stakeholder perceptions of key symptoms and health domains to test as patient-reported performance measures in oncology. Stakeholders included cancer patients, caregivers, clinicians, and healthcare administrators. Standard review methodology was used, consistent with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). MEDLINE/PubMed, EMBASE, and the Cochrane Library were searched to identify relevant studies through August 2020. Four coders independently reviewed entries and conflicts were resolved by a fifth coder. Efficacy and effectiveness studies, and studies focused exclusively on patient experiences of care (e.g., communication skills of providers) were excluded. Searches generated 1813 articles and 1779 were coded as not relevant, leaving 34 international articles for extraction. Patients, caregivers, clinicians, and healthcare administrators prioritize psychosocial care (e.g., distress) and symptom management for patient-reported performance measures. Patients and caregivers also perceive that maintaining physical function and daily activities are critical. Clinicians and administrators perceive control of specific symptoms to be critical (gastrointestinal symptoms, pain, poor sleep). Results were used to inform testing at six US cancer centers.
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Affiliation(s)
- Angela M. Stover
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC 27599, USA;
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
- Correspondence:
| | - Rachel Kurtzman
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC 27599, USA;
| | | | - Jennifer Jansen
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
| | - Philip Carr
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
| | - Thomas Atkinson
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - C. Tyler Ellis
- Department of Surgery, University of Louisville Health, Louisville, KY 40202, USA;
| | | | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA;
| | - Ethan M. Basch
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC 27599, USA;
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
- Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA;
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Experiences of older patients with cancer from the radiotherapy pathway - A qualitative study. Eur J Oncol Nurs 2021; 53:101999. [PMID: 34294576 DOI: 10.1016/j.ejon.2021.101999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/21/2021] [Accepted: 07/07/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE To explore and describe experiences of older patients with cancer throughout their radiotherapy treatment, from diagnosis until follow-up after treatment. METHODS Individual interviews were conducted to explore different phases of radiotherapy. Interviews were recorded and transcribed verbatim. Inductive content analysis was applied. Each interview was coded separately. Then to the codes were analyzed further, and an overall theme was developed. RESULTS Twelve older patients with cancer, (7 male, 5 female) aged ≥ 65 related their experiences from radiotherapy treatment. A main theme describes the essence of their experiences; Understanding "just enough". The theme comprises five main categories: Understandable, adapted information is crucial for trusting health services; Previous experiences influence patients' perception and understanding; Involvement of next of kin is crucial to patients' comprehension; Professional treatment decisions and well-organized treatment determines satisfaction and Experiences of cooperation and coordination of services affects dependability. CONCLUSIONS Findings from this study describe how understanding "just enough" - not too much nor too little - may assist older patients with cancer in participating in treatment decisions, preventing false beliefs, feeling reassured during treatment and in navigating the complex health care system. Next of kin are important assets for older patients with cancer in understanding "just enough". Cancer nurses may map comprehension of information, as well as reveal patients' previous experiences.
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Patients' Experience of Communication During Their Course of Treatment in an Oncology Outpatient Clinic: Qualitative Study. Cancer Nurs 2020; 45:E187-E196. [PMID: 33038098 DOI: 10.1097/ncc.0000000000000891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Communication between patients and healthcare professionals becomes increasingly important as patients with cancer are primarily treated in outpatient settings, where the time to communicate is brief. There is a need to understand patients' experiences of communication to ensure person-centered communication during treatment. OBJECTIVE The aim of this study was to explore how patients experience communication with healthcare professionals during their course of treatment in an oncology outpatient clinic to elucidate how their needs for support are met. METHODS Data were generated through semistructured qualitative interviews in patients with cancer who received treatment in an oncology outpatient clinic (n = 18). Interpretive description methodology and symbolic interactionism inspired the analytical approach. RESULTS Three overarching communication categories were generated, namely, verbal practices, relational practices, and nonverbal practices, which reflect distinct characteristics and the quality of the communication. Communication was characterized as being informative, cheerful, and routinized, which the patients found supportive and, contrarily, superficial, task focused, lacking continuity in care, and missing existential dimensions. CONCLUSION The communication practice in the oncology outpatient clinic especially supported patients in managing their treatment and side effects. However, psychological, social, and existential concerns were rarely addressed, requiring the patient to self-manage these issues in everyday life while living with cancer. IMPLICATIONS FOR PRACTICE Patients are socialized by verbal and nonverbal communication practices in the outpatient clinic, which influences their expectations of what to talk about during their treatment. Methods are needed to support person-centered communication in outpatient settings, so patient care needs are met more broadly.
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Ingemann C, Hansen NF, Hansen NL, Jensen K, Larsen CVL, Chatwood S. Patient experience studies in the circumpolar region: a scoping review. BMJ Open 2020; 10:e042973. [PMID: 33020108 PMCID: PMC7537463 DOI: 10.1136/bmjopen-2020-042973] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Patient experiences with health systems constitute a crucial pillar of quality care. Across the Arctic, patients' interactions with the healthcare system are influenced by challenges of access, historical inequities and social determinants. This scoping review sought to describe the range and nature of peer-reviewed literature on patient experience studies conducted within the circumpolar region. DESIGN In a partnership between Danish/Greenlandic, Canadian and American research teams, a scoping review of published research exploring patient experiences in circumpolar regions was undertaken. DATA SOURCES Seven electronic databases were queried: MEDLINE, Embase, Scopus, 'Global Health 1910 to 2019 Week 11', CINAHL, PsycINFO and SveMed+. ELIGIBILITY CRITERIA Articles were eligible for inclusion if they (a) took place in the circumpolar region, (b) reported patients' perspective and (c) were focussed primarily on patient experiences with care, rather than satisfaction with treatment outcome. DATA EXTRACTION AND SYNTHESIS Title and abstract screening, full-text review and data extraction was conducted by four researchers. Bibliometric information such as publication date and country of origin was extracted, as was information regarding study design and whether or not the article contained results relevant to the themes of Indigenous values, rural and remote context, telehealth and climate change. Two researchers then synthesised and characterised results relevant to these themes. RESULTS Of the 2824 articles initially found through systematic searches in seven databases, 96 articles were included for data extraction. Findings from the review included unique features related to Indigenous values, rural and remote health, telehealth and climate change. CONCLUSIONS The review findings provide an overview of patient experiences measures used in circumpolar nations. These findings can be used to inform health system improvement based on patient needs in the circumpolar context, as well as in other regions that share common features. This work can be further contextualized through Indigenous methodologies such as sharing circles and community based participatory methods.
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Affiliation(s)
- Christine Ingemann
- National Institute of Public Health, University of Southern Denmark Faculty of Health Sciences, Copenhagen, Denmark
- Institute of Nursing and Health Sciences, University of Greenland, Nuuk, Greenland
| | | | - Nanna Lund Hansen
- National Institute of Public Health, University of Southern Denmark Faculty of Health Sciences, Copenhagen, Denmark
| | - Kennedy Jensen
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Christina Viskum Lytken Larsen
- National Institute of Public Health, University of Southern Denmark Faculty of Health Sciences, Copenhagen, Denmark
- Institute of Nursing and Health Sciences, University of Greenland, Nuuk, Greenland
| | - Susan Chatwood
- University of Alberta School of Public Health, Edmonton, Alberta, Canada
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Prip A, Møller KA, Nielsen DL, Jarden M, Olsen MH, Danielsen AK. The Patient-Healthcare Professional Relationship and Communication in the Oncology Outpatient Setting: A Systematic Review. Cancer Nurs 2019; 41:E11-E22. [PMID: 28753191 PMCID: PMC6259679 DOI: 10.1097/ncc.0000000000000533] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2017] [Indexed: 12/02/2022]
Abstract
BACKGROUND Today, cancer care and treatment primarily take place in an outpatient setting where encounters between patients and healthcare professionals are often brief. OBJECTIVE The aim of this study was to summarize the literature of adult patients' experiences of and need for relationships and communication with healthcare professionals during chemotherapy in the oncology outpatient setting. METHODS The systematic literature review was carried out according to PRISMA guidelines and the PICO framework, and a systematic search was conducted in MEDLINE, CINAHL, The Cochrane Library, and Joanna Briggs Institute Evidence Based Practice Database. RESULTS Nine studies were included, qualitative (n = 5) and quantitative (n = 4). The studies identified that the relationship between patients and healthcare professionals was important for the patients' ability to cope with cancer and has an impact on satisfaction of care, that hope and positivity are both a need and a strategy for patients with cancer and were facilitated by healthcare professionals, and that outpatient clinic visits framed and influenced communication and relationships. CONCLUSIONS The relationship and communication between patients and healthcare professionals in the outpatient setting were important for the patients' ability to cope with cancer. IMPLICATIONS FOR PRACTICE Healthcare professionals need to pay special attention to the relational aspects of communication in an outpatient clinic because encounters are often brief. More research is needed to investigate the type of interaction and intervention that would be the most effective in supporting adult patients' coping during chemotherapy in an outpatient clinic.
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Affiliation(s)
- Anne Prip
- Author Affiliations: Institute of Nursing, Metropolitan University College, Copenhagen (Mss Prip and Møller); Departments of Oncology (Dr Nielsen and Ms Olsen) and Gastroenterology (Dr Danielsen), Herlev and Gentofte Hospital, University of Copenhagen; and University Hospitals Center for Health Research, Copenhagen University Hospital and University of Copenhagen (Dr Jarden), Denmark
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Prip A, Pii KH, Møller KA, Nielsen DL, Thorne SE, Jarden M. Observations of the communication practices between nurses and patients in an oncology outpatient clinic. Eur J Oncol Nurs 2019; 40:120-125. [PMID: 31229201 DOI: 10.1016/j.ejon.2019.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/04/2019] [Accepted: 03/19/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Effective communication in cancer care and treatment is linked to better health outcomes, improved treatment adherence, and improved quality of life for cancer patients. While the characteristics of effective communication have been identified, there is sparse knowledge about the current conditions for providing effective communication especially within the outpatient clinical context, where the majority of cancer patients are currently being treated. This study aimed to explore communication practices between nurses and patients undergoing chemotherapy in an outpatient clinic to gain insight into how patients are supported in this setting. METHODS Data were collected through 70 h of participant observations of nurse-patient interactions supplemented with ad hoc interviews with nurses in an oncology outpatient clinic. The methodology and data analysis are guided by interpretive description, thematic analysis and symbolic interactionism. RESULTS Three themes were generated that characterised communication in the outpatient clinic: Treatment-centred communication, efficient communication and spatially-bound communication. While there was good opportunity for patients to learn about treatment and side effects during cancer treatment, psychosocial concerns were rarely addressed. CONCLUSIONS The outpatient setting influences the type and quality of communication between nurses and patients. Improvement of communication should include not only verbal and written information, but focus on the importance of nonverbal communication in the oncology outpatient clinic. Furthermore, there is a need to make environmental adjustments that can facilitate the opportunity for patients to express their needs and for nurses to respond to them.
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Affiliation(s)
- Anne Prip
- Department of Nursing and Nutrition, University College Copenhagen, Tagensvej 86, 2200 Copenhagen N, Denmark.
| | - Kathrine H Pii
- Department of Nursing and Nutrition, University College Copenhagen, Tagensvej 86, 2200 Copenhagen N, Denmark.
| | - Kirsten A Møller
- Department of Nursing and Nutrition, University College Copenhagen, Tagensvej 86, 2200 Copenhagen N, Denmark.
| | - Dorte Lisbet Nielsen
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev Ringvej 75, 2730 Herlev, Denmark.
| | - Sally E Thorne
- School of Nursing, University of British Columbia, Canada.
| | - Mary Jarden
- Department of Hematology and Oncology, Copenhagen University Hospital, Rigshospitalet & Department of Public Health, University of Copenhagen, Denmark.
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Appleton L, Poole H, Wall C. Being in safe hands: Patients’ perceptions of how cancer services may support psychological well-being. J Adv Nurs 2018; 74:1531-1543. [DOI: 10.1111/jan.13553] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2018] [Indexed: 12/30/2022]
Affiliation(s)
- Lynda Appleton
- The Clatterbridge Cancer Centre NHS Foundation Trust; Bebington UK
| | - Helen Poole
- Faculty of Science; Liverpool John Moores University; Tom Reilly Building; Liverpool UK
| | - Christine Wall
- Faculty of Education, Health and Community; Liverpool John Moores University; Henry Cotton Building; Liverpool UK
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Corbett M, Heirs M, Rose M, Smith A, Stirk L, Richardson G, Stark D, Swinson D, Craig D, Eastwood A. The delivery of chemotherapy at home: an evidence synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundRecent policy and guidance has focused on chemotherapy services being offered closer to home, but the clinical and economic implications of this are uncertain.ObjectivesTo compare the impact of delivering intravenous chemotherapy in different settings on a range of outcomes, including quality of life, safety and costs.DesignMultimethods approach: systematic review of clinical effectiveness, qualitative and cost-effectiveness studies; description of the patient pathway and brief survey of current provision; and development of a decision model to explore aspects of cost-effectiveness.SettingProvision of intravenous chemotherapy.ParticipantsChemotherapy patients.InterventionsSetting in which chemotherapy was administered (home, community or outpatient).Outcome measuresSafety, quality of life, preference, satisfaction, opinions/experiences, social functioning, clinical outcomes, costs and resource/organisational issues.Data sourcesSixteen electronic databases (including MEDLINE, EMBASE and The Cochrane Library) were searched from inception to October 2013 for published and unpublished studies.Review methodsTwo reviewers independently screened potentially relevant studies, extracted data and quality assessed the included studies. Study validity was evaluated using appropriate quality assessment tools. Clinical effectiveness and cost-effectiveness studies were summarised narratively, and qualitative studies were synthesised using meta-ethnography.ResultsOf the 67 eligible studies, 25 were comparative, with nine including a concurrent economic evaluation. Although some of the 10 randomised trials were designed to minimise avoidable biases, slow recruitment rates and non-participation of eligible patients for setting-related reasons meant that trial sample sizes were small and populations were inherently biased to favour the home or community settings. There was little evidence to suggest differences between settings in terms of quality of life, clinical outcomes, psychological outcomes or adverse events. All nine economic evaluations were judged as having low or uncertain quality, providing limited evidence to draw overall conclusions. Most were cost–consequence analyses, presenting cost outcomes alongside trial results but deriving no summary measure of benefit. Poor resource use reporting and use of different perspectives across settings made results difficult to compare. Seventeen qualitative studies (450 participants) were judged as moderate to good quality, although all compared new or proposed services with existing outpatient facilities and biased samples were used. The three main lines of argument were barriers to service provision, satisfaction with chemotherapy and making compromises to maintain normality. Most patients made explicit trade-offs between the time and energy required for outpatient chemotherapy, which reduced quality of life, and an increased sense of safety. A patient pathway was described, informed by expert advice and a brief survey of NHS and private providers, which identified wide variation in the ways in which home and community chemotherapy was delivered. Considering limitations of the available data and variation in provision, cost-effectiveness modelling results were not robust and were viewed as exploratory only; the results were highly unstable.ConclusionsPrimary studies comparing settings for administering intravenous chemotherapy appear difficult to conduct. Consequently, few robust conclusions can be made about the clinical effectiveness and cost-effectiveness. Qualitative studies indicate that the patient time and energy required for outpatient chemotherapy reduces quality of life. A nested randomised controlled trial within a larger observational cohort of patients is proposed to enhance recruitment and improve generalisability of results. Future economic evaluations require detailed patient characteristic, resource use, cost and quality-of-life data, although their results are likely to have limited generalisability.Study registrationThis study is registered as PROSPERO CRD42013004851.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Mark Corbett
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Morag Heirs
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Micah Rose
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Alison Smith
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Lisa Stirk
- Centre for Reviews and Dissemination, University of York, York, UK
| | | | - Daniel Stark
- Leeds Institute of Cancer & Pathology, University of Leeds, Leeds, UK
| | - Daniel Swinson
- St James’s Institute of Oncology, Leeds Teaching Hospitals Foundation NHS Trust, Leeds, UK
| | - Dawn Craig
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Alison Eastwood
- Centre for Reviews and Dissemination, University of York, York, UK
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Social Philosophy and Oncology. SOCIAL THEORY & HEALTH 2014. [DOI: 10.1057/sth.2014.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Nissim R, Freeman E, Lo C, Zimmermann C, Gagliese L, Rydall A, Hales S, Rodin G. Managing Cancer and Living Meaningfully (CALM): a qualitative study of a brief individual psychotherapy for individuals with advanced cancer. Palliat Med 2012; 26:713-21. [PMID: 22042225 DOI: 10.1177/0269216311425096] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although psychosocial care has been regarded as central to palliative and supportive care, there have been few empirically tested approaches to individual intervention. AIM The subjective experience of advanced cancer patients receiving a new manualized brief individual psychotherapy, referred to as Managing Cancer and Living Meaningfully (CALM), was examined prior to the initiation of a randomized controlled trial testing the effectiveness of this intervention. DESIGN Semi-structured interviews were conducted with patients who had a diagnosis of advanced cancer, and who underwent the intervention. SETTING/PARTICIPANTS Patients were recruited from a large urban regional cancer center in Toronto, Canada. The 10 interviewees included seven women and three men. All had completed between three to six CALM sessions prior to the interview. RESULTS The CALM intervention was associated with profound and unique patient-identified benefits and no patient-identified risks or concerns. Five interrelated benefits of the intervention were identified: (1) a safe place to process the experience of advanced cancer; (2) permission to talk about death and dying; (3) assistance in managing the illness and navigating the healthcare system; (4) resolution of relational strain; and (5) an opportunity to 'be seen as a whole person' within the healthcare system. These benefits were regarded by participants as unique in their cancer journey. CONCLUSIONS Findings from a qualitative study suggest that the CALM intervention provides substantial benefits for patients with advanced cancer prior to the end of life. Findings informed the development of a randomized controlled trial to evaluate the effectiveness of this intervention.
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Affiliation(s)
- Rinat Nissim
- Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Canada.
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Hjörleifsdóttir E, Óskarsson GK. Psychological distress in Icelandic patients with repeated recurrences of cancer. Int J Palliat Nurs 2010; 16:586-92. [DOI: 10.12968/ijpn.2010.16.12.586] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Elísabet Hjörleifsdóttir
- Associate Professor, School of Health Sciences, University of Akureyri, 600 Akureyri, Iceland and a palliative care nurse at the hospice home care service in Akureyri
| | - Guðmundur Kr. Óskarsson
- Associate Professor, School of Business and Science, University of Akureyri, 600 Akureyri, Iceland
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Quality of Life and Symptoms of Anxiety and Depression of Patients Receiving Cancer Chemotherapy. Cancer Nurs 2010; 33:E1-E10. [DOI: 10.1097/ncc.0b013e3181b4adb5] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Rchaidia L, Dierckx de Casterlé B, De Blaeser L, Gastmans C. Cancer patients' perceptions of the good nurse: a literature review. Nurs Ethics 2009; 16:528-42. [PMID: 19671641 DOI: 10.1177/0969733009106647] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article discusses findings from a mixed method literature review that investigated cancer patients' perceptions of what constitutes a good nurse. To find pertinent articles, we conducted a systematic key word search of five journal databases (1998-2008). The application of carefully constructed inclusion criteria and critical appraisal identified 12 relevant articles. According to the patients, good nurses were shown to be characterized by specific, but inter-related, attitudes, skills and knowledge; they engage in person-to-person relationships, respect the uniqueness of patients, and provide support. Professional and trained skills as well as broad and specific nursing and non-nursing knowledge are important. The analysis revealed that these characteristics nurtured patient well-being, which manifests as optimism, trust, hope, support, confirmation, safety and comfort. Cancer patients' perceptions of what constitutes a good nurse represent an important source of knowledge that will enable the development of more comprehensive and practice-based views on good nursing care for such patients. These perceptions help us to understand how nurses effectively make a difference in cancer patient care.
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